Not all adenomyosis is equal: impact of direct adenomyosis features on live birth after ART cycles in a prospective cohort study.

Increasing maternal age showed a trend toward reduced live birth in multivariable models (all adenomyosis: aOR 0.88 per year, 95% CI 0.77-0.99, p=0.042; direct marker analysis: aOR 0.86 per year, 95% CI 0.75-0.99, p=0.037).

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Clinical outcomes The overall live birth rate was lower in the adenomyosis group compared to controls (28.9% vs 40.3%), though this did not reach statistical significance in univariate analysis (OR 0.60, 95% CI 0.34-1.04, p=0.076) ( Figure 1 ).

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After adjustment for age, BMI, and embryo transfer stage, adenomyosis remained associated with reduced live birth, though the effect was marginally non-significant (aOR 0.61, 95% CI 0.34-1.08, p=0.094) ( Table 2 , Figure 2 ).

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Our data broadly confirm this pattern of reduced live birth and increased miscarriage, but refine it by showing that the excess risk is largely concentrated in women with direct sonographic markers: when adenomyosis is defined simply as “any MUSA feature”, the effect on live birth is modest and of borderline significance, whereas focusing on direct markers alone reveals a nearly 60% reduction in the odds of live birth and an almost four-fold increase in miscarriages.

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